tbuckley/cabot-search huggingface dataset:
Abstract 122: The Impact Of The Covid-19 Pandemic On The Incidence Of Ems Treated Out-of-hospital Cardiac Arrest Patients And The Incidence Of Bystander Cardiopulmonary Resuscitation (cpr); A World-wide Perspective
Authors: Ingvild B Tjelmeland, Jo Kramer-Johansen, Jan Wnent, Jan-Thorsten Graesner
Journal: Circulation (2022)

Introduction: Survival after OHCA is dependent on early recognition, early cardiopulmonary resuscitation (CPR) and early defibrillation. The purpose of CPR is to maintain some blood flow until the arrival of the emergency medical services (EMS). Our concern was that the Covid-19 pandemic would have a negative effect on the number of patients who got CPR before EMS arrival. The aim of this study is to compare the incidence of EMS treated patients and the incidence of bystander CPR during the pandemic with data from before the pandemic. Method: This is a retrospective cohort study using data from existing cardiac arrest registries. The participants are from 24 countries, where Australia and USA have four regions each, resulting in 30 individual participants. All participating registries share aggregated data from 2017 to 2020, and results from before and after lockdown is compared. Poisson regression was used to look at differences. Results: Preliminary results from 14 registries show that the incidence of EMS treated patients per 100.000 inhabitants was statistically increased in five registries, decreased in three registries, and had no statistical difference in six registries. The incidence of bystander CPR was statistically higher after lockdown in five registries, decreased in one registry and was unchanged in eight registries. Four regions had an increase in both incidence of EMS treated patients and the incidence of bystander CPR. Conclusion: Bystanders willingness to perform CPR seems unchanged by the Covid-19 pandemic.
Abstract 12567: Cardiomyocyte Hypertrophy is Regulated by P300 Binding Protein 1, a Novel Binding Protein
Authors: Ayaka Ishima
Journal: Circulation (2022)

Background: Hypertrophic stimuli such as hemodynamic overload activate the cardiac signaling pathway that terminates in cardiomyocyte nuclei, thus changing the pattern of gene expression associated with cardiomyocyte hypertrophy. This hypertrophy eventually leads to systolic dysfunction and decompensated heart failure. Nuclear acetylation is a critical event in the activation of this hypertrophic gene expression and is mediated in part by intrinsic histone acetyltransferases (HAT) such as coactivator p300. p300-HAT activity is a potential pharmacological target for the prevention of heart failure. However, the regulation mechanism of p300-HAT activity is still unclear. In this study, we identified novel p300 binding partners by proteomic analysis and investigated the role of one of these proteins, p300 binding protein 1 (p300BP1), in the hypertrophic responses of cardiomyocytes. Methods and Results: To identify novel p300 binding proteins, cardiac-specific FLAG-p300 overexpressing mice were generated. Protein fractions from heart tissues of these mice and wild-type mice were purified with anti-FLAG-M2 agarose. Mass spectrometry analysis identified 553 novel p300 binding proteins, including kinases, phosphatases, methyltransferases, and transcriptional regulators. p300BP1 was selected for analysis. Binding was found to occur between baculovirus-expressed the recombinant genes FLAG-p300 full length and HA-p300BP1. The aa762-aa1098 fragment of p300 was required for this binding. In cultured cardiomyocytes, knockdown of p300BP1 prevented phenylephrine-induced increases in cardiomyocyte surface area and hypertrophic gene transcription factors such as ANF and BNP. Conversely, the overexpression of p300BP1 increased the surface area of cardiomyocytes and hypertrophic gene transcriptions. Furthermore, overexpression of p300BP1 significantly increased H3K9 acetylation in cultured cardiomyocytes. A reporter gene assay showed that p300BP1 enhanced p300/GATA4-mediated ANF and BNP promoter activation in HEK293T cells. Conclusions: We have identified multiple novel p300 binding proteins using a proteomics approach. p300BP1 may play an important role in p300/GATA4-dependent hypertrophic responses in cardiomyocytes.
Abstract 11595: Applying Machine Learning on Myocardial Deformation Parameters for Identifying Subjects in High Risk of Heart Failure: The Copenhagen City Heart Study
Authors: Rune Højlund, Jakob Oeystein Simonsen, Daniel Modin, Kristoffer G Skaarup, Mats Lassen, Niklas D Johansen, Sergio Sanchez, Brian Claggett, Jacob Marott, Magnus Thorsten, Gorm Jensen, Peter Schnohr, Rasmus Mogelvang, Tor Biering-Srensen
Journal: Circulation (2022)

Background Recently, speckle tracking echocardiography (STE) and tissue doppler imaging (TDI) has gained increasing traction as a non-invasive tissue characterisation method within cardiology. But until now many patterns from the strain and TDI curves remain uninvestigated. In this work we applied supervised machine learning (ML) to identify unknown pathophysiological drivers of heart failure (HF) in the general population. Methods A total of 2383 subjects from the general population (Mean age 55.9 years ± 17.3, male 42%) underwent STE, TDI, and clinical examination. We applied an ensemble decision tree and a logistic regression model to investigate unknown speckle tracking parameters and to predict the endpoint: Occurrence of HF within five years. The ML models were evaluated with 20-fold cross-validation to provide a clear split between training and validation data. Results The median follow up-time was 5.41 years (ICR 4.49 - 6.28). 88 subjects (3.7%) developed HF within 5 years.We identified 4 new echocardiographic characteristics that improved the prediction of HF: 1. Peak systolic strain rate (SRs), 2. Strain at AVC, 3. Accumulated systolic strain/HR, 4. TDI Peak LV Diastolic Acceleration(Figure 1 and Figure 2). The model combining both novel strain- and TDI parameters as well as conventional echo parameters and clinical features performed significantly better than a model based on clinical features alone (AUC echocardiographic and clinical parameters vs. clinical parameters = 0.88/0.84, p = 0.04). An ensemble decision tree model predicted the outcome reasonably well with a precision of 24% at a sensitivity of 50%. Conclusion Adding novel echocardiographic parameters to a clinical ML model for prediction of HF improved the prognostic performance significantly. We identified 4 new parameters relevant for prediction of HF and found that peak systolic strain rate (SRs) was the most important predictor.
Abstract 11247: Impact of Pre-Existing Heart Failure on Non-St Segment Elevation Myocardial Infarction Outcomes
Authors: Ahmad Gill, Omar Al-Taweel, Saba Al-Tarawneh, Mohammad Jaradat, DALIA HAWWASS, Chowdhury Ahsan
Journal: Circulation (2022)

Introduction: There is limited data examining how pre-existing heart failure impacts patients with a non-ST segment elevation myocardial infarction (NSTEMI). In this study, we compare the in-hospital outcomes of NSTEMI patients with chronic heart failure with reduced ejection fraction (HFrEF) against NSTEMI patients with chronic heart failure with preserved ejection fraction (HFpEF). Methods: We queried the National Inpatient Sample database (2016-2019) to identify patients admitted with a principal diagnosis of NSTEMI and a secondary diagnosis of chronic heart failure. We conducted propensity score matching using a greedy nearest neighbor 1:1 model. Multivariable logistic regression was used to compare mortality. Results: 51,564 patients met our inclusion criteria. Patients with a NSTEMI and chronic HFrEF had 1.71 times higher odds of suffering in-hospital mortality compared to NSTEMI patients with chronic HFpEF (aOR 1.71, 95% CI: 1.55-1.90; p &lt; 0.001). When separated by race, NSTEMI patients with HFrEF had a higher mortality rate amongst White patients (5.7% vs 4.4%, p &lt; 0.001, Figure 1). These patients also had higher rates of coronary artery disease, hypertension and prior myocardial infarction (Table 1). There was no difference in percutaneous coronary intervention (21.7% vs 21.5%, p = 0.60, Table 1) or postoperative cardiac arrest, cerebral infarction and hemorrhage between our two cohorts. Conclusions: Patients with a NSTEMI and chronic HFrEF had higher odds of suffering in-hospital mortality compared to NSTEMI patients with chronic HFpEF. Further studies should explore the interventions providers may undertake to better support this vulnerable population.
Abstract 11739: Cardiac Magnetic Resonance Imaging Derived Inferior Vena Cava Cross-Sectional Area Correlates With Measures of Fontan Associated Liver Disease
Authors: Megan Gunsaulus, Li Wang, Adam Christopher, Brian D Feingold, James Squires, Simon Horslen, Arvind Hoskoppal, Kirsten Rose-felker, Shawn C WEST, Sara Trucco, Judy Squires, Laura Olivieri, Jacqueline Kreutzer, Bryan H Goldstein, Tarek Alsaied
Journal: Circulation (2022)

Background: There is currently no clear consensus on appropriate screening techniques to evaluate the presence or severity of Fontan-associated liver disease (FALD). Cardiac MRI (CMR) is used routinely for post-Fontan surveillance, but CMR-derived measures that relate to the severity of FALD are yet to be defined. Methods: This was a cross-sectional single-center study of post-Fontan patients who underwent a CMR. CMR exams were re-analyzed by a single pediatric cardiologist. The inferior vena cava cross-sectional area (CSA) was measured on CMR and indexed to height (indexed IVC-CSA). Other CMR measurements included ventricular volumes and systolic function, ascending aorta flow, Fontan CSA, and pulmonary artery CSA. Surrogates of FALD included Gamma-Glutamyl Transferase (GGT), Fibrosis-4 laboratory score (FIB-4), and imaging findings. Findings consistent with cirrhosis on liver ultrasound included increased liver echogenicity and/or nodularity. Statistical analyses were performed to investigate potential relationships between CMR parameters and markers of FALD. Results: Sixty-one patients were included. The median age was 2.7 years at the time of Fontan surgery and 17.0 years at the time of CMR. A larger indexed IVC-CSA was significantly associated with a higher FIB-4 score (Spearman’s ρ = 0.28, P = 0.04), a higher GGT level (Spearman’s ρ = 0.40, P = 0.02), and findings consistent with cirrhosis on liver ultrasound (OR 1.17, 95% CI: (1.01, 1.35), P = 0.04). None of the other measured CMR parameters were associated with markers of FALD. A larger indexed IVC-CSA on CMR was associated with higher systemic ventricle end-diastolic pressure (EDP) on cardiac catheterization (Spearman’s ρ = 0.39, P = 0.018) as well as older age (Spearman’s ρ = 0.46, P = &lt;0.001). Conclusions: A larger indexed IVC-CSA was the only finding on CMR that was associated with markers of FALD. This measure has the potential to serve as an additional non-invasive tool for risk stratification of FALD.
Abstract 12735: Autoimmune Recurrent Pericarditis in Pregnancy: A Multidisciplinary Approach
Authors: Samia Mazumder, Rehan Karmali, Parvathy Ravi Sankar, Felix Berglund, Muhammad Majid, Allan L Klein
Journal: Circulation (2022)

Background: Recurrent pericarditis in pregnancy is uncommon and the data regarding the safety and efficacy of conventional therapy is sparse. We describe a multidisciplinary approach to managing a challenging case of chronic, recurrent pericarditis in the setting of newly-diagnosed systemic lupus erythematosus (SLE) and pregnancy. Case: 28-year-old female at 24 weeks gestation with no known medical history presents with sharp, pleuritic and positional chest pain and hypotension. Transthoracic echocardiography reveals acute, effusive pericarditis with features of tamponade. Despite emergent pericardiocentesis, pericardial window placement and treatment with steroids, she had recurrence of pericarditis the following month. Due to the recurrent nature of pericarditis of unknown etiology and pregnancy, clinicians were faced with a diagnostic and therapeutic dilemma. Decision Making: After extensive testing to rule out malignancy, bacterial and fungal infections, she was diagnosed with SLE - the culprit of her recurrent pericarditis. An multidisciplinary approach among cardiology, rheumatology and obstetrics was taken to determine an optimal therapeutic regimen and several risk-benefit discussions were conducted with the patient and family. In order to treat both recurrent pericarditis and SLE, she was tapered off of steroids initiated on Azathioprine 50 mg and low-dose Colchicine 0.3 mg twice daily. She was followed closely with cardiac MRI (Figure 1) and ultimately delivered a healthy child despite her new diagnoses. Conclusion: This case showcases the complexity of managing recurrent pericarditis in the setting of pregnancy and comorbid conditions and supports the use of Colchicine and Azathioprine for this population despite the lacking literature. This case also emphases the importance of multidisciplinary teamwork, clinical acumen and the value of patient-centered care when determining a course of therapy for a challenging patient.
Abstract 11148: Time-Varying Cardiovascular Effects of Sodium-Glucose Co-Transporter Inhibitors in Patients With Type 2 Diabetes: Insights From Pivotal Cardiovascular Outcome Trials
Authors: Ioannis Milioglou, Issam Motairek, Salil Deo, Ian Neeland, sanjay Rajagopalan, Sadeer Al-Kindi
Journal: Circulation (2022)

Introduction: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have been shown to reduce cardiovascular (CV) risk in patients with type 2 diabetes. Trial results reported as hazard ratios (HR) may be of limited use in shared decision-making. Restricted mean survival time (RMST) is an alternative reported in time units and can be easily interpreted. Hypothesis: We sought to investigate the effects of SGLT2i on CV outcomes using RMST in pivotal trials in patients with type 2 diabetes. Methods: Data from 5 trials of SGLT2i (CANVAS, CREDENCE, EMPAREG-OUTCOME, DECLARE-TIMI 58, VERTIS CV) for the following end-points: major adverse cardiovascular events (MACE: myocardial infarction, stroke, and cardiovascular death), heart failure hospitalizations (HFH), cardiovascular death and all-cause mortality was extracted from the Kaplan Meier curves. For each trial, we calculated the RMST difference (ΔRMSTs) between SGLT2i and placebo arms, which were then pooled using random effect models. Results for all trials were extrapolated till 7 years (CANVAS trial maximum follow-up), when necessary, using flexible parametric model Results: Four trials were included for MACE (CANVAS, EMPAREG OUTCOME, VERTIS CV, DECLARE TIMI 58). dRMST for MACE increased non-linearly over time from year 1 (1.2 [0.2-2.2] days) to year 7 (19.5 [5.3-33.8] days). For HFH (CANVAS, EMPAREG OUTCOME, VERTIS CV), dRMST increased non-linearly from year 1 (1.2 [0.7-1.7] days) to year 7 (26.3 [15.2-37.3] days), Figure. For CV death (CANVAS, CREDENCE, EMPAREG OUTCOME, VERTIS CV), dRMST increased non-linearly from year 1 (0.6 [0.2-1.1] days) to year 7 (34.8 [3.3-66.4] days). For all-cause mortality (CANVAS, CREDENCE, EMPAREG OUTCOME, DECLARE-TIMI 58), dRMST increased non-linearly from year 1 (0.2 [-0.1-0.6] days) to year 7 (39.1 [2.8-75.5] days). Conclusions: SGLT2i are associated with a statistically significant, time-dependent, non-linear delay in MACE, HFH, cardiovascular and all-cause deaths.
Abstract 12536: Type A Aortic Dissection in a Young Marfanoid Filipino Male Eventually Developing Fungal Mediastinitis: A Case Report
Authors: Ray Z Perez, Jun Maximo F Lasco
Journal: Circulation (2022)

Introduction: Aortic Dissection (AD) results from a tear between the layers of the aorta. This is often seen among older males or those with heritable connective tissue disorders, and it mostly presents as chest pain. Management involves surgical repair wherein post procedure complications are to be expected. Mediastinitis, or deep sternal wound infection, however, is likewise unusual. Case Presentation: We present a case of a 29-year-old Filipino male presenting with sudden diffuse abdominal pain; he had no comorbidities and had no significant history suggestive of connective tissue disorders. Physical examination was mostly unremarkable. CT Aortogram revealed presence of dissection from the proximal ascending aorta up to the common iliac arteries, with the entry tear measuring 8.5mm at the level of T5, with extension to the proximal branches of the aortic arch, both common carotid arteries, right renal, right internal and external iliac arteries. Echocardiogram also showed a normal aortic valve but with dilated sinus of Valsalva(4.5cm, z-score 5.13). The patient underwent a Modified Bentall Procedure with Cabrol Shunt, with delayed closure of operative site due to extensive bleeding. Cystic medial necrosis was not seen on biopsy. After developing persistent post-operative fever, repeat chest CT showed a fluid collection in the mediastinum encasing the ascending aorta and main pulmonary trunk; culture of abscess fluid was positive for Candida tropicalis . He was then given prolonged parenteral followed by oral antifungal therapy and subsequently discharged improved. Discussion: Vascular causes of abdominal pain should be considered in patients with scant history and physical findings. Major vascular surgery has expected complications such as bleeding and infection; the management of such complications should incorporate a multidisciplinary approach as in such cases, a trial of medical management may be safer than repeat surgery.
Abstract 12566: Use Of Aortic Valve Area Index By Actual Body Weight Overestimates Aortic Stenosis Severity In Obese Patients
Authors: Lixia Deng, Mengyun Lu, Chen Bao, Brian C Downey, Benjamin S Wessler
Journal: Circulation (2022)

Introduction: Guidelines recommend indexing aortic valve area (AVA) to body surface area in grading the severity of aortic stenosis (AS), which overestimates severity in obese patients. The indexing of AVA to ideal or adjusted body weight has not been explored. Hypothesis: We hypothesized that using actual body weight compared to ideal or adjusted body weight in obese patients would result in overestimation of the severity of AS using AVAi. Methods: We conducted retrospective chart review on 305 individuals who received a transthoracic echocardiogram (TTE) at Tufts Medical Center from June 2021 to Sept. 2021 with AVA &lt;1.5cm 2 . We selected 73 subjects with moderate AS (AVA 1-1.5cm 2 ). These subjects were divided into an overweight and obese group (BMI &gt; 25; n = 56) and a normal weight group (BMI 18-24.9; n = 17). We recorded baseline characteristics and TTE data. AVAi was calculated with actual, ideal, and adjusted body weight. The primary outcome was reclassification, defined as a change in severity from severe AS to mild or moderate AS after recalculating AVAi using adjusted or ideal body weight. Results: The overweight and obese group was significantly younger (age 74.4±11.2 versus 80.7±5.7 years, P=0.018) with higher BSA (2.0±0.2 versus 1.7±0.2, P=0.010) compared to the normal weight group. The recorded median AVAi was 0.61 with interquartile range(IQR) of 0.17. There was no significant difference in blood pressure, ejection fraction, AVA, peak aortic velocity, peak gradient, and mean gradient. After calculating AVAi with adjusted and ideal body weight, 18 patients in the overweight and obese group were reclassified to a lower grade of AS based on AVAi (median AVAi 0.58, IQR 0.17), compared with 0 reclassifications in the normal weight group (0.67, 0.18). Patients who were reclassified had a significantly smaller AVA compared to patients who were not reclassified (1.09±0.11 versus 1.23±0.19 cm 2 , P&lt;0.001), while no differences were observed in peak gradient, mean gradient, and peak velocity. Conclusions: Using actual body weight to calculate AVAi in overweight and obese patients can lead to overestimation of AS severity. Further research is needed to investigate the optimal indexing strategy for AVAi and the effects of classification on cardiovascular outcomes.
Abstract 11425: Association of Glycemic Control With Cardiovascular Outcomes in Adult Cancer Survivors With Elevated Fasting Blood Glucose Level: A Population-Based Cohort Study
Authors: Kyuwoong Kim, Sanghyun Oh
Journal: Circulation (2022)

Introduction: Management of blood glucose level is recommended for prevention of cardiovascular disease (CVD) and other health outcomes by well-regarded guidelines. However, whether glycemic control is associated with incident CVD in adult cancer survivors with elevated fasting blood glucose (FBG) level remains unknown. Hypothesis: We hypothesized that adult cancer survivors with elevated FBG level (FBG≥100 mg/dL) whose FBG level was lowered to the normal range (FBG&lt;100 mg/dL) would be at lower risk of incident CVD compared to those whose FBG level was persistently elevated. Methods: Population-based cohort study derived from the National Health Insurance Service database identified adult cancer survivors between January 1, 2002 and December 31, 2005 who underwent the two consecutive biennial national health screening program (2007-2008 and 2009-2010) in the Republic of Korea. Follow-up data for incident CVD and death from CVD or other causes was obtained from the medical claims records and death registry, respectively. Each survivor was followed-up from January 1, 2011 to December 31, 2019 until incident CVD, death from CVD or other causes, whichever came first. The risk estimates for CVD outcomes were computed with Cox proportional hazards model adjusted for age, sex, insurance premium, lipid profile, hypertension, obesity, cigarette smoking, and physical activity among adult cancer survivors with and without glycemic control. Results: A total of 4,959 adult cancer survivors with elevated FBG level was identified in the NHIS database. Among these survivors, proportion of those whose FBG level was lowered to the normal range was 36.2% (n=1,785). After adjusting for sociodemographic, lifestyle, and clinical characteristics, adult cancer survivors with lowered FBG level compared to those who had persistently elevated FBG level were less likely to be at risk of incident CVD (adjusted hazard ratio=0.69; 95% confidence intervals: 0.24-1.98). Conclusions: No statistically significant risk estimate was observed in this analysis, which is likely to be underpowered. Well-designed observational studies are needed to examine the association of glycemic control with CVD events among adult cancer survivors with elevated FBG level.